Provider Demographics
NPI:1184099616
Name:MAHAL, JASJEET K
Entity type:Individual
Prefix:MISS
First Name:JASJEET
Middle Name:K
Last Name:MAHAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7524 SOUTHSIDE BLVD
Mailing Address - Street 2:APT. 1315
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7012
Mailing Address - Country:US
Mailing Address - Phone:423-552-5185
Mailing Address - Fax:
Practice Address - Street 1:8301 CYPRESS PLAZA DR
Practice Address - Street 2:SUITE 124
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4420
Practice Address - Country:US
Practice Address - Phone:904-574-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health